Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 24 , ISSUE 10 ( October, 2020 ) > List of Articles

CASE REPORT

Acute Necrotizing Encephalitis as a Probable Association of COVID-19

Subhash Kumar, Binod K Pati, Chandramani Singh, Asim Sarfraz

Keywords : Acute necrotizing encephalitis, Altered sensorium, Computed tomography, COVID case report, Coronavirus disease 2019 in India, Encephalopathy, Magnetic resonance imaging

Citation Information : Kumar S, Pati BK, Singh C, Sarfraz A. Acute Necrotizing Encephalitis as a Probable Association of COVID-19. Indian J Crit Care Med 2020; 24 (10):991-994.

DOI: 10.5005/jp-journals-10071-23636

License: CC BY-NC 4.0

Published Online: 30-10-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Meanwhile, over 50 lakh people have now been affected by coronavirus disease 2019 (COVID-19) across the globe. There are various reports on neurological manifestations of COVID-19, which have attracted broad attention. Acute necrotizing encephalopathy (ANE) is a rare complication of influenza and other viral infections and has been related to intracranial cytokine storm, which results in breach in blood–brain barrier leading to encephalitis like presentation. We report an unusual case of acute necrotizing encephalitis as a solitary presentation of COVID-19. Case description: We report a case of 35-year-old man from Bihar, presented to our emergency department in unconscious state, with high-grade fever and vomiting since last 5 days. Previous magnetic resonance imaging (MRI) brain showed a left parasellar-middle cranial fossa mass looks most likely like an invasive meningioma. Urgent non contrast computed tomography scan (NCCT) brain showed that mass as well as hypodensities in both thalami and left caudate nucleus. As per our institutional protocol, clinical management of raised intracranial pressure was initiated. As there is no current evidence from any randomized control trails (RCTs) to recommend any specific treatment for suspected or confirmed patients with COVID-19 with acute necrotizing encephalitis. Conclusion: Our case highlights the importance of identifying encephalitis as a presenting sign of COVID-19 based on NCCT findings with normal cerebrospinal fluid (CSF) and normal chest X-ray (CXR) findings.


  1. “A Novel Coronavirus from Patients with Pneumonia in China, 2019 | NEJM.”.
  2. “WHO Director-General's Opening Remarks at the Media Briefing on COVID-19 - 11 March 2020.”.
  3. Rossi A. Imaging of acute disseminated encephalomyelitis. Neuroimaging Clinics 2008;18(1):149–161. DOI: 10.1016/j.nic.2007.12.007.
  4. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020;395(10229):1033–1034. DOI: 10.1016/S0140-6736(20)30628-0.
  5. Liao X, Wang B, Kang Y. Novel coronavirus infection during the 2019-2020 epidemic: preparing intensive care units-the experience in Sichuan Province, China. Intensive Care Med. 2020;46(2):357–360. DOI: 10.1007/s00134-020-05954-2.
  6. Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, et al. Nervous system involvement after infection with COVID19 and other coronaviruses. Brain Behav. Immun. 2020;87:18–22. DOI: 10.1016/j.bbi.2020. 03.031.
  7. Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: a retrospective case series study. (2020).Accessed: March 21, 2020: https://www.medrxiv.org/content/10.1101/2020.02.22.20026500v1.
  8. Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, et al. Neurological associations of COVID-19. Lancet Neurol 2020;19(9):P767–P783. DOI: 10.1016/S1474-4422(20)30221-0.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.